Provider Demographics
NPI:1659328268
Name:MERCY HOSPITAL SPRINGFIELD
Entity Type:Organization
Organization Name:MERCY HOSPITAL SPRINGFIELD
Other - Org Name:MERCY PHARMACY-ST ROBERT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIR-RETAIL PHARMACY SVCS
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-628-5606
Mailing Address - Street 1:586 OLD ROUTE 66
Mailing Address - Street 2:PO BOX 1170
Mailing Address - City:ST ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3729
Mailing Address - Country:US
Mailing Address - Phone:573-336-2180
Mailing Address - Fax:573-336-3529
Practice Address - Street 1:586 OLD ROUTE 66
Practice Address - Street 2:
Practice Address - City:ST ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-3729
Practice Address - Country:US
Practice Address - Phone:573-336-2180
Practice Address - Fax:573-336-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020756183500000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2634815OtherNCPDP #
MO605986702Medicaid
MO0326010018Medicare NSC